Monday, March 12, 2012

Question time for Dr Sylvia Vigh Brisbane's Gastroenterologist and Hepatologist on "How to investigate for Ulcerative Colitis?"

Ulcerative colitis is the more common form of inflammatory bowel disease. It is thought to arise from a disordered immune system to the gut contents in genetically predisposed individuals. Below is a short outline in diagnosing this chronic relapsing and remitting disorder.

Laboratory Test
Though these are not diagnostic these are helpful in assessing and monitoring disease.
Routine bloods including FBC, ELFT
Raised LFT – multifactorial
Extra intestinal manifestation – primary sclerosing cholangitis (PSC)
Inflammatory markers..Non specific but aid in determination of severity of inflammation

Serological markers
Positive ASCA or pANCA no diagnostic but may differentiate ulcerative colitis from Crohn’s Disease and indeterminate colitis.

Faecal calprotectin
Sensitive marker for bowel inflammation
Not disease specific
Increased in malignancy, infections and NSAI inflammation
Useful to distinguish IBD from functional disorder

Stool cultures
Exclude infectious course, particularly Clostridium difficle as many patients have been empiric antibiotics prior to diagnosis.

CT imaging
Enteroclysis (CT or MRI)
Allow imaging of the small bowel – degree of inflammation and strictures

Endoscopic studies
Uniformly inflamed mucosa
Granular, erythematous appearance
Friability and loss of vascularity
Severe disease
Shallow ulceration (usually different to Crohn’s disease with deep serpiginous ulceration) and spontaneous bleeding
Occasional involvement of the distal ileum
Termed backwash ileitis (different appearance to true ileitis seen in Crohn’s disease with ulceration and possible strictures.)

Histological evaluation
Restricted to mucosal layer
Infiltrates of predominantly lymphocytes, plasma cells
More specific features include
Goblet cell depletion
Distorted crypt architecture
Diminished crypt density
Dysplasia – usually with long standing UC but can occur at any stage.
No criteria for diagnosis of UC but in most cases the presence of 2-3 aforementioned histologic features will suffice.

The most important thing is to consider it in your differential diagnosis and consider early referral for colonoscopy. Often patients have a delayed referral to the gastroenterologist and therefore more severe inflammation and sequelae such as muscle wasting, anaemia and hypoalbuminemia.

Please do not hesitate to contact me for referrals or patient information

Dr Sylvia Vigh
Gastroenterologist and Hepatologist
Mater Medical Centre
Ph 30105780 Fax 30105781

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